Summary
Job Description:
Baptist Health is looking for a Revenue Integrity RN to join our team! This is a remote work position that requires residency in KY or IN
Performs payor compliance review on accounts to determine medical necessity of services, pre and post service as well as pre and post billing. Obtains predeterminations / prior authorizations when required by payor. Reviews medical necessity denials from commercial and governmental payors, including pre-denial audits performed by RACs or similar Medicare and Medicaid programs. Responds to all denials or pre-denial audits with best possible efforts to recover outstanding revenue or prevent future revenue loss, meeting all appropriate payor or government timelines. Serves as clinical resource for other Revenue Integrity staff.
Qualifications:
Valid Kentucky licensure as a registered nurse.
Minimum three years healthcare experience (nursing, registration, patient accounting, financial services, managed care or a related field) or a Bachelor’s Degree in a related field and two years healthcare experience.
Requires knowledge of medical terminology; payor reimbursement guidelines (authorization / notification, medical necessity, and timely filing guidelines); payor denial appeal / underpayment resolution processes; and managed care contracts. Individuals working with government audits must have a keen understanding of all audit response requirements and timelines.
Work Experience
Education